Moving off the bench and into the game: Using fiscal agents to increase resources and foster innovation in public health

Public health agencies (PHA) are expected to adopt innovative strategies, such as environmental, policy and systems change to address new challenges like the obesity epidemic. But PHAs have found innovation daunting due to parent governmental bureaucratic structures which impose rigid personnel, procurement, and operations rules. Major funding initiatives, most recently distribution of health-focused federal stimulus dollars, have required public health agencies to rapidly adopt new strategies and expend large grant awards. Mirroring the private sector, some PHAs have partnered with fiscal agents to serve as vehicles for innovation and rapid action. This case presents the experience of the Cook County Department of Public Health (CCDPH) in partnering with the Public Health Institute of Metropolitan Chicago (PHIMC) as its fiscal agent for several grant funded initiatives, most significantly a two-year, sixteen million dollar Communities Putting Prevention to Work Obesity Prevention Grant. Little guidance is available for using fiscal agents by PHAs. While benefits appear obvious, selecting a fiscal agent, structuring the relationship, and successfully working together present legal, administrative, financial and programmatic issues. This case study examines key aspects of CCDPH/PHIMC relationship including early lessons on how this relationship streamlined resource procurement processes, increased organizational problem solving, enhanced expertise and work capacity, and fostered innovation. Key steps for accountability and transparency as well improving leadership and programmatic management are also examined.